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Illinois Department of Revenue

ST-2-X   Amended Multiple Site Form  
Attach to Form ST-1-X.                                                                                                                                REV            001   
                                                                                                                                                      FORM           010
                                                                                                                                                      Do not write above this line.
Account ID: ____ ____ ____ ____  -  ____ ____ ____ ____         Business name:  ___________________________________

Reporting period you are amending: __ __/__ __/__ __ __ __ through __ __/__ __/__ __ __ __  
                                  Month    Day       Year       Month    Day      Year
Write the figures that should have been filed.  You must round your figures to whole dollars.                                          Base (a)  X  rate = tax (b)   

Site where taxable sales were made
                                                                General merchandise
Location code    _____________________________________            4a  _______________                                                  X   _______  =  4b  ________________ 
Site name        _____________________________________                                                                                 (rate)
Site address     _____________________________________          Food, drugs, and medical appliances
                                                                  5a  _______________                                                   X   _______  =  5b  ________________ 
                                                                                                                                       (rate)
                 _____________________________________          Receipts taxed at other rates
City, state, ZIP _____________________________________            8a  _______________                                                          8b           ________________

                                                                General merchandise
Location code    _____________________________________            4a  _______________                                                  X   _______  =  4b   ________________ 
Site name        _____________________________________                                                                                 (rate)
                                                                Food, drugs, and medical appliances
Site address     _____________________________________            5a  _______________                                                   X   _______  =  5b  ________________ 
                                                                                                                                       (rate)
                 _____________________________________          Receipts taxed at other rates
City, state, ZIP _____________________________________            8a  _______________                                                          8b           ________________ 

                                                                General merchandise
Location code    _____________________________________            4a  _______________    X   _______  =  4b                                                 ________________ 
Site name        _____________________________________                                                                                 (rate)
                                                                Food, drugs, and medical appliances
Site address     _____________________________________            5a  _______________                                                  X   _______  =  5b   ________________ 
                                                                                                                                       (rate)
                 _____________________________________          Receipts taxed at other rates
City, state, ZIP _____________________________________            8a  _______________                                                          8b           ________________ 

                                                                General merchandise
Location code    _____________________________________            4a  _______________                                                   X   _______  =  4b  ________________ 
Site name        _____________________________________                                                                                 (rate)
                                                                Food, drugs, and medical appliances
Site address     _____________________________________            5a  _______________                                                   X   _______  =  5b  ________________ 
                                                                                                                                       (rate)
                 _____________________________________          Receipts taxed at other rates
City, state, ZIP _____________________________________            8a  _______________                                                          8b           ________________ 

                                                                General merchandise
Location code    _____________________________________            4a  _______________                                                  X   _______  =  4b   ________________ 
Site name        _____________________________________                                                                                 (rate)
                                                                Food, drugs, and medical appliances
Site address     _____________________________________            5a  _______________                                                  X   _______  =  5b   ________________ 
                                                                                                                                       (rate)
                 _____________________________________          Receipts taxed at other rates
City, state, ZIP _____________________________________            8a  _______________                                                          8b           ________________

                                                                General merchandise
Location code    _____________________________________            4a  _______________                                                  X   _______  =  4b   ________________ 
Site name        _____________________________________                                                                                 (rate)
                                                                Food, drugs, and medical appliances
Site address     _____________________________________            5a  _______________                                                  X   _______  =  5b   ________________ 
                                                                                                                                       (rate)
                 _____________________________________          Receipts taxed at other rates
City, state, ZIP _____________________________________            8a  _______________                                                          8b           ________________ 

                                                                                                                                       *901011110*
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed.  Disclosure of this 
information is required.  Failure to provide information may result in this form not being processed and may result in a penalty.  
ST-2-X (R-05/09)                   Printed by the authority of the state of Illinois - Web only, One copy

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